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Herr D, Wischnewsky M, Joukhadar R, Chow O, Janni W, Leinert E, Fink V, Stüber T, Curtaz C, Kreienberg R, Blettner M, Wollschläger D, Wöckel A. Does chemotherapy improve survival in patients with nodal positive luminal A breast cancer? A retrospective Multicenter Study. PLoS One 2019; 14:e0218434. [PMID: 31283775 PMCID: PMC6613686 DOI: 10.1371/journal.pone.0218434] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/02/2019] [Indexed: 12/15/2022] Open
Abstract
Background In this study based on the BRENDA data, we investigated the impact of endocrine ± chemotherapy for luminal A, nodal positive breast cancer on recurrence free (RFS) and overall survival (OS). In addition, we analysed if tumor size of luminal A breast cancer influences survival in patients with the same number of positive lymph nodes. Methods In this retrospective multi-centre cohort study data of 1376 nodal-positive patients with primary diagnosis of luminal A breast cancer during 2001–2008 were analysed. The results were stratified by therapy and adjusted by age, tumor size and number of affected lymph nodes. Results In our study population, patients had a good to excellent prognosis (5-year RFS: 91% and tumorspecific 5-year OS 96.5%). There was no significant difference in RFS stratified by patients with only endocrine therapy and with endocrine plus chemo-therapy. Patients with 1–3 affected lymph nodes had no significant differences in OS treated only with endocrine therapy or with endocrine plus chemotherapy, independent of tumor size. Patients with large tumors and more than 3 affected lymph nodes had a significant worse survival as compared to the small tumors. However, despite the worse prognosis of those, adjuvant chemotherapy failed in order to improve RFS. Conclusions According to our data, nodal positive patients with luminal A breast cancer have, if any, a limited benefit of adjuvant chemotherapy. Tumor size and nodal status seem to be of prognostic value in terms of survival, however both tumor size as well as nodal status were not predictive for a benefit of adjuvant chemotherapy.
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Affiliation(s)
- Daniel Herr
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
- * E-mail:
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Ralf Joukhadar
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Olivia Chow
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Elena Leinert
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Visnja Fink
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Tanja Stüber
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Carolin Curtaz
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
| | - Rolf Kreienberg
- Department of Obstetrics and Gynaecology, Ulm University Medical Centre, Ulm, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynaecology, Würzburg University Medical Centre, Würzburg, Germany
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Cserni G, Charafe-Jauffret E, van Diest P. Inflammatory breast cancer: The pathologists' perspective. Eur J Surg Oncol 2018; 44:1128-1134. [DOI: 10.1016/j.ejso.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 12/20/2022] Open
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Macrophages Enhance Migration in Inflammatory Breast Cancer Cells via RhoC GTPase Signaling. Sci Rep 2016; 6:39190. [PMID: 27991524 PMCID: PMC5171813 DOI: 10.1038/srep39190] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/21/2016] [Indexed: 01/06/2023] Open
Abstract
Inflammatory breast cancer (IBC) is the most lethal form of breast cancer. All IBC patients have lymph node involvement and one-third of patients already have distant metastasis at diagnosis. This propensity for metastasis is a hallmark of IBC distinguishing it from less lethal non-inflammatory breast cancers (nIBC). Genetic profiling studies have been conducted to differentiate IBC from nIBC, but no IBC cancer-cell-specific gene signature has been identified. We hypothesized that a tumor-extrinsic factor, notably tumor-associated macrophages, promotes and contributes to IBC’s extreme metastatic phenotype. To this end, we studied the effect of macrophage-conditioned media (MCM) on IBC. We show that two IBC cell lines are hyper-responsive to MCM as compared to normal-like breast and aggressive nIBC cell lines. We further interrogated IBC’s hyper-responsiveness to MCM using a microfluidic migration device, which permits individual cell migration path tracing. We found the MCM “primes” the IBC cells’ cellular machinery to become extremely migratory in response to a chemoattractant. We determined that interleukins −6, −8, and −10 within the MCM are sufficient to stimulate this enhanced IBC migration effect, and that the known metastatic oncogene, RhoC GTPase, is necessary for the enhanced migration response.
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Diessner J, Wischnewsky M, Blettner M, Häusler S, Janni W, Kreienberg R, Stein R, Stüber T, Schwentner L, Bartmann C, Wöckel A. Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study. PLoS One 2016; 11:e0168730. [PMID: 27992550 PMCID: PMC5167411 DOI: 10.1371/journal.pone.0168730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/05/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision. METHODS In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading. RESULTS There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46-1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45-1.88). CONCLUSIONS The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings-that are in line with several publications-should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.
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Affiliation(s)
- Joachim Diessner
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen Bremen, Germany
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), University of Mainz, Mainz, Germany
| | - Sebastian Häusler
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Wolfgang Janni
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Rolf Kreienberg
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Roland Stein
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Tanja Stüber
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Lukas Schwentner
- Department for Obstetrics and Gynecology, University of Ulm Medical School Ulm, Germany
| | - Catharina Bartmann
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
| | - Achim Wöckel
- Department for Obstetrics and Gynecology, University of Würzburg Medical School, Würzburg, Germany
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Bartmann C, Wischnewsky M, Stüber T, Stein R, Krockenberger M, Häusler S, Janni W, Kreienberg R, Blettner M, Schwentner L, Wöckel A, Diessner J. Pattern of metastatic spread and subcategories of breast cancer. Arch Gynecol Obstet 2016; 295:211-223. [PMID: 27832352 DOI: 10.1007/s00404-016-4225-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/02/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE The development of metastases is the most aggressive attribute of breast cancer. In this retrospective multicenter study, we evaluated if and how the different pathological breast cancer subtypes influence the spreading of tumor cells, the development of metastasis and the survival of breast cancer patients. METHODS This retrospective German multicenter study is based on the BRENDA collective including 9625 breast cancer patients treated in the adjuvant setting. We used the χ 2 tests for the analysis of the categorical variables between groups of patients with different sites of metastasis. Survival distributions and median survival times were estimated using the Kaplan-Meier product-limit method. The log-rank test was applied to compare survival rates. The Cox proportional hazards model was used to estimate the hazard ratio and confidence intervals. RESULTS 886 women developed metastases during a time interval of 53 months after primary diagnosis. Luminal A tumor patients were more likely to get bone metastases than lung, liver or CNS metastases. Patients with a triple-negative subtype were, however, the least affected by metastasis in the skeleton. They were most likely to develop visceral metastases. Location, numbers of metastases herein and the subtype influenced the overall survival (OAS). Altogether, the best OAS was found in patients with the luminal A subtype, the worst in patients with the triple-negative subtype. CONCLUSIONS Knowledge of the typical metastatic pattern of the subtypes of breast cancer will help to personalize therapeutic options and follow-up examinations of cancer patients.
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Affiliation(s)
- Catharina Bartmann
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
| | - Manfred Wischnewsky
- Faculty of Mathematics and Computer Science, University of Bremen, Universitätsallee GW1, 28359, Bremen, Germany
| | - Tanja Stüber
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Roland Stein
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Mathias Krockenberger
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Sebastian Häusler
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Wolfgang Janni
- Department for Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Rolf Kreienberg
- Department for Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), University of Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany
| | - Lukas Schwentner
- Department for Obstetrics and Gynecology, University Hospital of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Achim Wöckel
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Joachim Diessner
- Department for Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
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